Tres problemas nutricionales emergentes en poblaciones en contexto de vulnerabilidad / Three emerging nutritional problems in populations in vulnerable contexts

RESUMEN La primera infancia es un periodo de extrema vulnerabilidad debido al desarrollo rápido de la arquitectura cerebral de los niños y niñas durante estos años. Es una ventana de oportunidad para proteger a los niños de las condiciones adversas teniendo en cuenta que las inequidades en salud en las poblaciones continúan incrementándose. Esta revisión presenta tres problemas emergentes que contribuyen al incremento de estas inequidades en los niños y niñas durante la primera infancia: la ganancia excesiva de peso gestacional (GEPG) y la diabetes gestacional, la vulnerabilidad de las madres lactantes a la comercialización agresiva de sucedáneos de la leche materna (SLM) y la alfabetización en salud. Se exponen estrategias para el medio clínico para intervenir en estas tres condiciones: un enfoque de la GEPG que considere las determinantes de la salud, conocer el Código internacional de comercialización de sucedáneos de la leche Materna (SLM) así como su impacto sobre la protección de la lactancia materna, y se presentan las precauciones universales para alfabetización en salud. Finalmente, se insiste en la necesidad de enfoques holísticos y en la complementariedad de enfoques individuales y poblacionales para disminuir las brechas de las inequidades en salud en los niños durante la primera infancia.

ABSTRACT Early childhood is an extremely vulnerable period due to the rapid development of children's brain architecture during those years. It is a window of opportunity to protect children from adverse conditions, considering that health inequities within populations continue to increase. This review presents three emerging problems that contribute to the increase in these inequities in children during early childhood: excessive gestational weight gain (GWG), the vulnerability of mothers to the aggressive marketing of breast milk substitutes industry and health literacy. Strategies in the clinical setting are exposed to taking action: an approach that considers the determinants of health in excessive GWG, be aware of the International Code of Marketing of Breastmilk Substitutes and its impact on the protection of breastfeeding and the universal health literacy precautions. It also highlights the need for holistic approaches and the complementarity of individual and populational approaches to reduce gaps in early childhood health inequities.

Effects of excessive weight gain during pregnancy on offspring health: a review / 预防医学

@#Excessive gestational weight gain has already become a global clinical and public health problem that seriously affects maternal health. Excessive gestational weight gain not only increases the cesarean section rate and induces adverse pregnant outcomes, but also affects offspring development and health. This article reviews the effects of excessive weight gain during pregnancy on offspring health and its underlying mechanisms. Excessive gestational weight gain may increase the risk of obesity, cardiovascular diseases, infectious diseases of the respiratory tract, diabetes, polycystic ovary syndrome, mental or psychological illness among offspring, and the pathophysiological mechanisms include inflammatory response, intestinal flora dysbiosis and epigenetics theory. However, further studies are required to validate these hypotheses and to evaluate the effect of excessive weight gain at different gestational stages on offspring health, so as to provide insights into reasonable management of weight gain during pregnancy and improvements of offspring health.

The impact of excessive gestational weight gain on fetal hepatic lipid metabolism and the regulatory mechanism / 中华实用儿科临床杂志

Objective:A rat model of excessive gestational weight gain (EGWG) was constructed to investigate the impact of EGWG on fetal hepatic lipid metabolism and the relevant regulatory mechanism.Methods:Healthy Sprague-Dawley rats were caged together and tested for pregnancy.Rats with the sperm observed under microscope were considered pregnant for 0.5 days.Pregnant rats were divided into the normal diet (ND) group and high-fat diet (HFD) group by the random number table method, with 8 rats in each group.The body weight during pregnancy of the pregnant rats was recorded.Cesarean section was performed at day 21.5 of gestation and the birth weight of the fetal rats was recorded.Hepatic lipid deposition of the pregnant and fetal rats was examined by hematoxylin-eosin (HE) staining and oil red O staining.Triglyceride (TG) and cholesterol (TC) levels in livers and serum of the pregnant and fetal rats were detected by glycerol phosphate oxidase-peroxidase(GPO-PAP) method.The mRNA and protein expression levels of key genes FASN and SREBP1c in hepatic lipid metabolism of fetal rats were measured by real-time polyme-rase chain reaction (RT-PCR) and Western blot.Differences between the two groups were compared by independent sample t test. Results:There was no difference in pre-pregnancy body weight between the HFD group and the ND group, but the differences in the weight and the weight gain during pregnancy gradually enlarged between the two groups.At day 21.5 of gestation, the weight of the pregnant rats[(467.75±22.05) g vs.(430.88±18.80) g, t=-3.600, P=0.003], the weight gain of the pregnant rats during pregnancy[(181.50±9.68) g vs.(148.50±10.86) g, t=-6.415, P<0.001] and the birth weight of the fetal rats[(5.51±0.17) g vs.(4.85±0.35) g, t=-4.779, P<0.001] of the HFD group were significantly higher than those of the ND group.Both HE staining and oil red O staining presented increased hepatic lipid deposition in the pregnant and fetal rats of the HFD group.The hepatic and serum TG and TC levels of the pregnant and fetal rats of the HFD group were significantly higher than those of the ND group (all P<0.05). RT-PCR and Western blot showed that the mRNA and protein levels of key genes FASN and SREBP1c in hepatic lipid metabolism of fetal rats of the HFD group were significantly higher than those of the ND group (all P<0.05). Conclusions:An EGWG model can be successfully constructed by a 21-day HFD during pregnancy.EGWG can lead to hepatic lipid deposition in the fetal rats.The mechanism may be related to the expression changes of key genes FASN and SREBP1c in hepatic lipid metabolism of fetal rats.

Prospective cohort study on the risks of pre-pregnancy overweight, excessive gestational weight gain on macrosomia / 中华流行病学杂志

Objective: To investigate the risks of pre-pregnancy overweight, excessive gestational weight gain on macrosomia. Methods: We conducted one hospital-based cohort study, focusing on pregnant women from January 2015. All pregnant women attending to this hospital for maternal check-ups, were included in our cohort and followed to the time of delivery. Data related to general demographic characteristics, pregnancy and health status of those pregnant women, was collected and maternal pre-pregnant BMI and maternal weight gain were calculated. Logistic regression was used to explore the risk difference of pre-pregnancy BMI, excessive gestational weight gain on macrosomia. Results: The overall incidence of macrosomia in our cohort appeared as 6.6% (149/2 243). After adjusting the confounding factors including age and histories on pregnancy, pre-pregnancy overweight/obesity was associated with higher risks of macrosomia (OR=3.12, 95%CI: 1.35-7.22, P=0.008; OR=2.99, 95%CI: 1.17-7.63, P=0.022) when comparing to those with normal pre-pregnancy weight. Cesarean delivery and sex of the offspring were associated with higher risk of macrosomia, while excessive gestational weight gain showed no significant difference (OR=1.41, 95%CI: 0.96-2.09, P=0.084). Our data showed that Macrosomia was statistically associated with gestational weight gain (P=0.002). After controlling parameters as age, history of pregnancy and related complications of the pregnant women, results from the logistic regression showed that women with gestational inadequate weight gain having reduced risks to deliver macrosomia, when compared to those pregnant women with adequate weight gain (OR=0.52, 95%CI: 0.30-0.90, P=0.019). Conclusion: Pre-pregnancy overweight and obesity were on higher risks to macrosomia.

Prospective cohort study on the risks of pre-pregnancy overweight, excessive gestational weight gain on macrosomia / 中华流行病学杂志

Objective To investigate the risks of pre-pregnancy overweight,excessive gestational weight gain on macrosomia.Methods We conducted one hospital-based cohort study,focusing on pregnant women from January 2015.All pregnant women attending to this hospital for maternal check-ups,were included in our cohort and followed to the time of delivery.Data related to general demographic characteristics,pregnancy and health status of those pregnant women,was collected and maternal pre-pregnant BMI and maternal weight gain were calculated.Logistic regression was used to explore the risk difference of pre-pregnancy BMI,excessive gestational weight gain on macrosomia.Results The overall incidence of macrosomia in our cohort appeared as 6.6％ (149/2 243).After adjusting the confounding factors including age and histories on pregnancy,prepregnancy overweight/obesity was associated with higher risks of macrosomia (OR=3.12,95％ CI:1.35-7.22,P=0.008;OR=2.99,95％CI:1.17-7.63,P=0.022) when comparing to those with normal pre-pregnancy weight.Cesarean delivery and sex of the offspring were associated with higher risk of macrosomia,while excessive gestational weight gain showed no significant difference (OR=1.41,95％CI:0.96-2.09,P=0.084).Our data showed that Macrosomia was statistically associated with gestational weight gain (P=0.002).After controlling parameters as age,history of pregnancy and related complications of the pregnant women,results from the logistic regression showed that women with gestational inadequate weight gain having reduced risks to deliver macrosomia,when compared to those pregnant women with adequate weight gain (OR=0.52,95％ CI:0.30-0.90,P=0.019).Conclusion Pre-pregnancy overweight and obesity were on higher risks to macrosomia.

Meta-analysis of relationship of excessive weight gain during pregnancy and the risk of macrosomia / 现代临床护理

Objective To explore the relationship between excessive gestational weight gain and the risk of macrosomia. Methods Three databases were systematically reviewed and reference lists of relevant articles from January 2001 to December 2014 were checked. Meta-analysis of published epidemiological studies (cohort and case-control studies) was done. The odds ratio (OR) was used to evaluate the relationship of excessive gestational weight gain and macrosomia delivery. Results Twelve relevant articles were included to analyze, including 4 cohort studies and 8 case-control ones. The values of OR and 95%CI of macrosomia in pregnant women with excessive and non-excessiveweight gain were 1.66 (1.49, 1.83). Conclusion The risk of macrosomia in pregnant women with excessive gestational weight gain is much higher than those with normal gestational weight gain.

Ejercicio y prevención de obesidad y diabetes mellitus gestacional / Exercise in the prevention of excessive gestational weight gain and gestational diabetes

La obesidad y la diabetes tipo 2 están aumentando a nivel mundial y generan gran morbilidad y mortalidad, y afectan al paciente, la familia y al sistema de salud. Los niveles bajos de actividad física están contribuyendo con la epidemia de obesidad y diabetes tipo 2 en mujeres en edad fértil. La mayoría de las mujeres siguen el sedentarismo o suspende el ejercicio cuando se dan cuenta del embarazo, lo cual predispone al desarrollo de diabetes gestacional y a ganancia excesiva de peso durante el embarazo. Está demostrado que el ejercicio durante el embarazo es seguro para la madre y el feto, y brinda beneficios fisiológicos, psicológicos, metabólicos y mejora la capacidad física de una manera similar al periodo preconcepcional. Aunque no está definida la prescripción de ejercicio exacta durante el embarazo, actualmente se recomienda lograr un nivel de actividad física de mínimo 16 MET Hora por semana, o preferiblemente 28 MET Hora por semana, e incrementar la intensidad del ejercicio a más del 60 por ciento de la frecuencia cardiaca de reserva, para disminuir el riesgo de obesidad o ganancia excesiva de peso en el embarazo, diabetes gestacional y quizás trastornos hipertensivos asociados al embarazo. Por lo tanto, el ejercicio puede ser una estrategia adecuada para prevenir estas patologías que generan morbilidad y mortalidad materna y fetal.

Obesity and type 2 diabetes are increasing worldwide and generate high morbidity and mortality and affect the patient, family and the health system. Low levels of physical activity are contributing to the epidemic of obesity and type 2 diabetes in women of childbearing age. Most women are sedentary or stop exercising when they realize the pregnancy, which predisposes to the development of gestational diabetes and excessive weight gain during pregnancy. There is ample evidence that exercise during pregnancy is safe for mother and fetus and provides physiological, psychological, metabolic benefits, and improving physical capacity in a manner similar to the preconception period. Although not defined the exact exercise prescription during pregnancy, achieve currently recommended level of physical activity at least 16 MET H per week, or preferably 28 MET H per week, and increase the intensity of exercise over 60 percent of heart rate reserve to reduce the risk of obesity or gain excessive weight during pregnancy, gestational diabetes and perhaps hypertensive disorders of pregnancy. Therefore, exercise may be an appropriate strategy to prevent these pathologies leading to morbidity and mortality maternal and fetal.